Step by Step


The Pathway to Successful Weight Loss Surgery

Weight loss surgery is different from most other surgical procedures because it will affect your health and dietary habits for the rest of your life. Therefore, you will need to be completely prepared, medically and emotionally, to undergo surgery.

To help guide your way through this very involved process, our Weight Loss Surgery Team has created the following guide.


Step 1: Obtain Information about our Process [back to top]

Download our Weight Loss Surgery Workbook

Why a Workbook?

The process of preparing for weight loss surgery may take many months and involve many appointments with medical specialists. All of this is designed to make your process as safe and successful as possible.

In addition to meeting with your surgeon, you will meet with a dietician, a psychologist and a number of other medical specialists. In order to help you navigate your way through this process, this web site can be very useful. Many patients appreciate having a printed handbook as well.

You may download a copy of the Weight Loss Surgery Patient Workbook by clicking here .

You may also request that we mail a copy of the workbook to your address by calling our office. Please call (612) 625-8425 to request a workbook by mail.


Step 2: Is Weight Loss Surgery Right for Me?[back to top]

Morbid Obesity: Is weight loss surgery right for me?

We adhere to the National Institute of Health (NIH) guidelines for weight loss surgery and recommend these procedures strictly for patients with morbid obesity. The NIH guidelines use Body Mass Index (BMI), which is a calculated number based on your height and weight, to define morbid obesity. If your BMI exceeds 40.0 kg/m 2 and you have no medical problems, or if your BMI is in the range of 35.0-39.9 kg/m2 and you have significant obesity-related medical problems (such as diabetes, esophageal reflux disease or obstructive sleep apnea), then you are morbidly obese. Please be sure to ask questions about qualifying for surgery if your BMI does not exceed 40.0 kg/m2. Click here to read about the rationale for weight loss surgery.

Determining Morbid Obesity

To determine if weight loss surgery is right for you, calculate your obesity level using a BMI calculator, like the one found at: http://www.nhlbisupport.com/bmi/ You may also find your BMI by going to Appendix A of the "Preoperative Workbook ", which contains a BMI table. If you have further questions about your specific situation or are interested in scheduling a weight loss surgery consultation, please contact us by telephone at 612-626-6666.

Please click here to read about the rationale for the surgical treatment of morbid obesity. Aside from surgery, there is no durable, effective treatment for patients who are 100 pounds or more overweight.

Step 3: Letter from your Primary Care Doctor [back to top]

The decision to proceed with weight loss surgery is an important one, and your primary care provider should be involved at all stages of this process. Click here for a letter to your primary care doctor .

Prior to your seminar, we encourage you to schedule an appointment with your primary medical provider to discuss your attempts to lose weight and your diagnosis of morbid obesity. It is not mandatory for you to meet in person about this, but your primary care office should at minimum be notified about your intention to attend a seminar and see a surgeon about weight loss surgery.

Your insurance company will require a letter from your primary care provider describing your history of weight loss attempts, including diets, medications, exercise, and lifestyle interventions. This letter should detail the length of time that you have been morbidly obese and the length of time that you have been attempting to lose weight. In addition, you should transfer your past medical and surgical records to our surgical team.

Step 4: Medical and Diet History Questionnaire[back to top]

In order for us to better understand your medical history and to provide the best possible care, you will fill out a weight and medical history questionnaire prior to visiting individually with the surgery team. Click here for the medical and diet history questionnaire . You may also receive a printed copy at your seminar visit or by requesting that we e-mail or mail a copy to you.

Please be sure to carefully and accurately fill in every section to the best of your ability.

Please bring the filled-out questionnaire to your surgical consultation. We may not be able to evaluate you without a questionnaire available.


Step 5: Seminar and Visit with Surgeon [back to top]

Weight Loss Surgery Seminar

The process of weight loss surgery is much more than just an operation - it is a journey that is comprised of many small steps. Each step brings you a little bit closer toward your ultimate goal - a healthy weight! As you are reading this information, you are taking the first step down that path.

We require that all patients interested in weight loss surgery attend an informational seminar. In many situations, the seminar may be coordinated with a surgical consultation on the same day. Please call 612-626-6666 to sign up for a seminar and consultation with one of our surgeons.

Many people are interested in finding out more about weight loss surgery, but are not quite ready to schedule a consultation. For these individuals, the Minimally Invasive Weight Loss Surgery Center at University of Minnesota Medical Center, Fairview offers the opportunity to attend seminars without surgical consultation on a first-come, first-serve basis. Because both patients and family members are encouraged to attend, we have limited space for these seminars. In addition to a discussion of surgical treatments for morbid obesity, there will also be an opportunity to ask our surgeons questions about obesity treatment.

For a schedule of upcoming seminars, please refer to the calendar of patient information seminars online at, http://www.uofmmedicalcenter.org/Clinical_Services/Weight/c_131088.asp or call 612-626-6666.

Minimally Invasive Weight Loss Surgeon Consultation

If you continue with the process after the seminar, you will meet with one of our laparoscopic surgeons about the right weight loss surgery for you. If you do not have an appointment scheduled, please call 612-626-6666 to set up a consult.

When meeting with the doctor, you will get a recommendation as to which of the types of surgery is best for you. Our doctors perform LapBand, laparoscopic and open Roux-en-Y gastric bypass, laparoscopic and open duodenal switch and the sleeve gastrectomy. While most of the procedures are done laparoscopically, it is possible that an open procedure may be necessary due to your health history or weight.

You should also expect to meet with one of our dieticians on the day of your surgical consultation. They will assist you in understanding what you will be able to eat after surgery and also help you with a plan to lose weight before surgery. Many insurance companies are now requiring 3 or more documented dietician visits prior to authorizing weight loss surgery, so it is important to document one visit during the seminar and consultation visits.

Step 6: Requirements for Surgery [back to top]

At your consult appointment, your weight will be measured. From this day forward, you cannot gain any weight. Your weight will also be checked at your preoperative appointment three weeks prior to surgery. If you have gained weight, your surgery may be canceled.

After your consultation with our surgeon, you will receive an outline of the preoperative evaluations that need to be completed prior to surgery. This should serve as a checklist for you and will assist in making the journey easier to navigate.

You may view a sample of this preoperative requirement checklist by clicking here .
In the back of the "Preoprative Workbook ", you will find a list of psychologist and letters to your various healthcare providers, including:


A list of psychologists that our patients have previously used in Appendix C
A request for the psychological evaluation in Appendix D.
A sample letter to your primary care provider in Appendix E.
Please note that we do not require a cardiology or pulmonary consultation for all patients, but we have included a letter to your cardiologist in Appendix F and a letter to your pulmonologist in Appendix G, in the event that we request these consultations.

Step 7: Follow-up Appointment with Primary Care Doctor [back to top]

After attending the informational seminar and surgeon consult, you will need to schedule an appointment with your primary care provider. They will be able to assist you in coordinating your evaluation before surgery. They will need to review your history as well as complete lab work.

Many insurance companies require documented non-surgical weight loss attempts before approving weight loss surgery. For that reason, it will be important to check through your medical records with your primary care provider for documented heights and weights in the past.

Your provider can also make referrals to complete your psychological evaluation and other required testing. If your insurance company requires a referral to be seen for weight loss surgery, please make sure that you are referred to the Minimally Invasive Weight Loss Surgery Center at University of Minnesota Medical Center, Fairview instead of to a specific surgeon. This will make sure that you are able to see all of the different providers in our program if necessary.

As mentioned in Step 3, another important part of your visit with your primary care provider is obtaining a letter that documents your past medical weight loss attempts, as well as your past medical and surgical history. It should also state whether or not your primary care provider supports your interest in having weight loss surgery. This letter is very helpful in obtaining insurance company approval. You may view a sample of this primary care provider letter by clicking here.


Step 8: Insurance Approval for Surgery [back to top]

Please click here to access most up-to-date information about insurance coverage, including an overview of the most common insurance plans in Minnesota.

 

Step 9: Schedule Your Operation [back to top]

You may schedule your surgery after you have undergone psychological evaluation. To schedule surgery with Dr. Ikramuddin or Dr. Andrade, call Cheryl Palony at 612-624-6102. To schedule surgery with Dr. Kellogg or Dr. Leslie, call Desi Schieber at 612-624-6671. All dates are tentative until the insurance authorization is complete and the psychological evaluation and other testing are completed. Final clearance for surgery will be given in the final 7 days before surgery by your primary care provider at your history and physical appointment.

Before your operation can be confirmed, we need to have approval from your insurance company (prior authorization) Most insurance companies now require that you meet their BMI requirements, as well as having a letter from your primary care provider, a psychological evaluation, and documented dietary visits (3 or 6 visits at one month intervals).

When your operation is scheduled, you will also be given an appointment for a preoperative nurse appointment as well as a one week follow-up appointment. It is always a good idea to obtain a copy of any test results for your records. If you do not hear from a scheduler shortly after your last test has been faxed to us, please call one of the schedulers to check on the status of your records.


Step 10: Patient Education Class [back to top]

Our goal is to do everything we can to make your surgery and recovery as successful as possible. To help prepare you for your surgical experience, we have developed an educational program that is designed to give you information about your operation and recovery. It is very helpful to attend this class prior to attending your preoperative appointment.

We have found that people who understand their operation and know what to expect afterwards have a smoother recovery. Both families and patients tell us that this educational program is beneficial and comforting to them.

The program is offered every Tuesday from 11:00 AM - 12:30 PM and every Wednesday from 3:00 - 4:30 PM, and is located on the 3rd floor of the Masonic Cancer Center Building on the University of Minnesota Twin Cities campus, in Room 302. You may bring a guest to this class. Please call Fairview On Call at 612-672-7247 to pre-register. It is recommended that you attend this class approximately 2-3 weeks before your surgery.

What to Expect

The class is taught by a nurse who will explain what to do the night before surgery, what to expect during hospitalization and what lifestyle changes to prepare for after discharge. Information about discharge planning and services available after hospitalization will be provided.

Questions

If you have further questions about the Minimally Invasive Weight Loss Surgery class or to arrange a class date, please call the Patient Learning Center at 612-273-4894 (hours 8:00 am - 5:00 pm). To arrange a class date, call Fairview On Call at 612-672-7247.


Step 11: Final Visit with Surgery Team before Weight Loss Surgery[back to top]

Three weeks before surgery you will come into the clinic for a weight check, urinalysis, and hemoglobin evaluation. At this visit you should have a surgery date and time. It is important to be at your goal weight for surgery or your surgery may need to be rescheduled. You many need to go on a liquid diet 2-3 weeks before surgery.

At this appointment, you will meet with one of our clinic nurses who will review your medications, check your weight, and order laboratory tests.

This is the final appointment with our team prior to surgery. Following this visit you will receive phone calls from our offices and the hospital with final instructions about your operation.

Any acute illnesses will be addressed during this visit. Common treatable conditions identified at this time include urinary tract infections, sinusitis, bronchitis, and low iron or potassium levels. Most of the time these illnesses are not terribly concerning for patients, but they can complicate surgery if not treated in a timely fashion.


Step 12: History and Physical with your Primary Care Doctor [back to top]

You need to have a history and physical (H&P) evaluation by your primary care provider in the last 7 days before surgery. This H&P is a standard preoperative assessment required by our hospital and the anesthesia team prior to any operation. The purpose is to ensure that any last-minutes items are squared away before your operation.

You should also have a 12-lead EKG at this appointment.

The documented H&P should be faxed to our offices (612-625-7272) and you should hand-carry a copy to the hospital on the day of your operation.


Step 13: Your Operation[back to top]

Before Your Operation

It is very important that you lose at least a small amount of weight prior to your surgery. The amount of weight was listed on your "Preoperative Requirements" worksheet. Some patients find this confusing: "why should I have to lose weight before the operation, if I'm having the operation to help me lose weight?"

The answer is simple. Your liver is a large organ that sits right in front of your stomach. When you lose weight (even if it's only a few pounds) much of that weight comes from your liver. This means that your liver gets smaller, making it easier and safer for the surgeon to gain access to your stomach. This also reduces the risk of having to convert the operation from a laparoscopic to an open one.

Unfortunately, some patients take the wrong approach, eating "like there's no tomorrow" before their surgery. This makes their liver grow and become infiltrated with fat. A fatty liver is heavy, brittle, and more likely to suffer injury during surgery. It is important to avoid this trap, and to lose, not gain, weight before your operation. There is no single diet that works for everyone during this time -- most patients use a diet that has worked (at least temporarily) for them in the past.

For the two days immediately prior to surgery, you should follow a diet of clear liquids only. This will help to clear your small intestine of any solid material that could potentially interfere with surgery. You can continue the liquids until midnight the night before your surgery. At that point, you need to be strictly NPO -- nothing by mouth. During this NPO time after midnight, it is still OK to take medications with a small sip of water. But remember, no breakfast, coffee or ANYTHING BESIDES MEDICATION the morning of your operation!

Hospital Location

Most of our operations are performed at the University of Minnesota Medical Center, Fairview on the East Bank campus of the Mississippi River. A detailed map will be provided with the confirmation letter for your appointment.

University campus
500 Harvard St. SE
Minneapolis, MN 55455
Phone number for both campuses: (612) 273-3000

Parking

Patients and visitors may park in the Patient/Visitor parking ramp on Delaware Street. All parking facilities include handicapped-designated spaces. In addition, there are two parking spaces between the Malcolm Moos Tower and the Phillips-Wangensteen Building on Delaware Street that are designated for handicapped use. Wheelchairs are available at the clinic, hospital and ramp entrances. You may also ask staff at any information desk to call for a wheelchair.

The Day of Surgery

You will come to the hospital on the day of your surgery. An operating room nurse will call you the day before surgery to tell you exactly when to arrive, and to notify you of the time your surgery will begin. Most patients are instructed to arrive two hours before their surgery. This gives you time to meet your anesthesiologist, have an I.V. placed, and receive pre-medication to help you relax before surgery.

Your operation may be as short as 1-1/2 hours, or up to 3 hours or even more, depending upon your weight, your prior surgery history, and the complexity of the operation you're having. Your family can wait in the surgical waiting area, where your surgeon will come down to speak with your family after it is over.

After your operation, you will go to the Recovery Room, known officially as the Post-Anesthesia Care Unit (PACU) to recover from anesthesia. You will then be transferred to our post-weight loss surgery patient floor (7B) for your post-operative stay. You will be able to see your family again once you are transferred to your hospital room.


Step 14: First Few Weeks after Your Operation [back to top]

Discharge from the Hospital

Your hospital stay will depend on what type of operation you have. If you undergo laparoscopic Roux-en-Y gastric bypass, the most common length of stay is two days.

Medications after Discharge

You will receive a prescription for pain medication before your discharge.

The surgical team will coordinate your final medication list prior to discharge. In general, high blood pressure, psychiatric, thyroid, and anti-depression medications are resumed after surgery. Medications for high cholesterol and oral diabetic medications are typically discontinued. If you have diabetes, you should stay on an insulin sliding scale after surgery. Diuretic medications (water pills) are discontinued if possible.

If you still have your gallbladder and undergo Roux-en-Y gastric bypass or duodenal switch, then you will receive a prescription for ursodiol (Actigall) prior to discharge or at your first postoperative appointment. This prevents gallstone formation during the period of rapid weight loss and is continued for six months after surgery.

Vitamins will be started in clinic after surgery.

Stitches

If you undergo LapBand surgery, you will have absorbable sutures under the skin and steri-strips over the incisions. There are no sutures or staples to remove. If you undergo laparoscopic Roux-en-Y gastric bypass or laparoscopic duodenal switch your laparoscopic incisions will be closed with staples, then converted to steri-strips on the day of discharge. You should not need to have stitches or staples removed once you leave the hospital.

Physical Activity

You should feel free to try any physical activity that feels comfortable to you. It is OK to lift about 10 pounds -- roughly the weight of one gallon of milk -- but not much more. It is certainly OK to walk, climb stairs, stretch, and even jog, if you feel up to it. You should avoid any contact sports at this time.

Driving

It is not OK to drive a car until you have been off all narcotic pain medication for several days. When you do resume driving, start with slow, easy trips around the neighborhood-- you should avoid trips longer than 30 minutes for at least one month if possible!

Taking Off Work

Most patients take three or four weeks off from work, although some highly motivated patients go back after just one or two weeks. Once you are a week or more out from your surgery, there is no medical reason why you cannot resume work activities, so long as your job does not require strenuous physical activity. The main determinant of your readiness to return to work is how you feel. Even though your incisions might not be long on the outside, you still had a general anesthetic and your body still needs to heal after the operation. This can cause you to feel weak even though it doesn't seem like you should feel that way.

First Follow-up Visit

Your first follow-up appointment is made at the time you schedule your operation and occurs at one week after surgery. At this visit, your surgeon will carefully examine your incisions to see if they have healed well. If so, you will be given a clean "bill of health" and will be able to resume all activities including bathing, swimming, and all exercises.


Step 15: Follow-up Schedule [back to top]

Clinic Appointments

All post-weight loss surgery patients are expected to follow-up six times after surgery in the first year, twice per year for each subsequent year for the next four years and then annually. All of these visits are with the surgeon, the nurse practitioner or the physician assistant.

You may schedule an appointment with one of our registered dieticians on any of these postoperative visits.

Year One Schedule
1 week, 1 month, 3 months, 6 months, 9 months, 12 months

Years Two Through Four
Schedule Every 6 months

Years Five and Beyond Schedule
Annual

Postoperative Laboratory Testing

We obtain laboratory data on all of our patients at three months after surgery and then at yearly intervals. These are necessary to screen for nutritional deficiencies after surgery.

Support Group

We provide patients with an opportunity to attend support groups after surgery. Many patients find it helpful to talk to others who have gone through this surgery and are having similar experiences. These meetthe first Wednesday of each month at 6:30 pm at the location below.

Brennan Center
Riverside East Building University of Minnesota Medical Center, Fairview - Riverside Campus
2450 Riverside Ave.
Minneapolis, MN 55454
Email newu@umn.edu for details

 


 
 

Central Scheduling: 612.672.7422

Provider Referrals: 612.672.7000

Administrative Offices: 612.884.0600
 

©2012 Regents of the University of Minnesota. All rights reserved.